B77 Tubulointerstitial nephritis Flashcards Preview

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Flashcards in B77 Tubulointerstitial nephritis Deck (5)
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1
Q

What are the types of Tubulointerstitial nephritis

A

Usually TIN is caused by bacterial infection and the renal pelvis is prominently involved, as a part of pyelonephritis.

Interstitial nephritis is a term reserved for non-bacterial inflammation, even though it still involves both the tubules and interstitium

  • includes Acute Interstitial Nephritis
  • and Analgesic Papillary Necrosis

In either case, the glomeruli are usually not involved or only become involved late in the course of severe cases.

2
Q

What are the causes of interstitial nephritis?

A

Drug-induced hypersensitivity reaction involving the interstitium and tubules

  • NSAIDs, penicillin, and diuretics
3
Q

What is the histology/morphology of Acute Interstitial Nephritis?

A

Hypersensitivty reaction within the tubules and interstitium,

  • Interstitial and tubular edema
  • Lymphocytes, macrophages, mononuclear cells, neutrophils and especially
  • Eosinophils
  • Normal glomeruli - (except in some cases of NSAID where there is foot process efacement and nephrosis)
4
Q

What is the clinical course of acute interstitial nephritis?

A

Requires a latent period after exposure to the drug. Usually about 2 weeks.

This is consistent with a hypersensitivity reaction ,as it takes times for the IgE to be syntehsized and accumulated on the eosinophils.

Symptoms:

  • fever
  • rash (in 25%)
  • oliguria/anuria
  • azotemia
  • no proteinuria
  • leukocyturia and eosinophiluria

Resolves with drug cessation, but can be severe enough to cause potential papillary necrosis first.

5
Q

Pathogenesis of analgesic nephritis

A

Causes chronic interstitial nephritis and often papillary necrosis.

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